Effects of prophylactic fibrin glue on post-gastric ESD bleeding in gastric neoplasm: A meta-analysis of randomized controlled trials.

Abstract

e16148 Background: Post-procedural bleeding remains a significant complication following gastric endoscopic submucosal dissection (ESD), occurring in up to 15% of cases. Fibrin glue has been proposed as a protective barrier to mitigate this risk. We conducted a meta-analysis of randomized controlled trials (RCTs) to synthesize current evidence regarding the efficacy of fibrin glue in preventing post-ESD bleeding. Methods: A systematic review identified three RCTs (Kim 2025, Lee 2023, Kataoka 2019) comparing fibrin glue application versus standard care in patients undergoing gastric ESD. A total of 636 patients were included (318 fibrin glue; 318 standard care). The primary outcome was overall post-ESD bleeding within 4 weeks. Secondary outcomes included acute ( < 24 hours) and delayed ( > 24 hours) bleeding. Pooled risk ratios (RR) were calculated using random-effects models. Results: The analysis revealed no significant reduction in overall post-ESD bleeding with fibrin glue compared to control (9.7% vs. 10.7%; RR 0.91, 95% CI 0.57–1.44). Heterogeneity for the primary outcome was negligible (I 2 = 0.0%), indicating highly consistent findings across studies. Furthermore, no significant differences were observed in secondary outcomes, including acute bleeding (RR 0.72, 95% CI 0.15–3.44) or delayed bleeding (RR 1.11, 95% CI 0.52–2.36). While acute bleeding rates were numerically lower in the intervention group (3.9% vs. 5.5%), this did not reach statistical significance. Conclusions: Based on high-quality evidence from recent RCTs, prophylactic fibrin glue application does not significantly reduce bleeding rates following gastric ESD. The data suggest that routine use of fibrin glue is unwarranted in the general patient population. Future research should pivot toward identifying specific high-risk subgroups that may derive benefit, rather than unselected prophylaxis.